You are a pharmacist at a specialist outpatient clinic. You received a prescription for tamoxifen 20 mg PO daily for a 57 year old lady with breast cancer. 

a) What information would you obtain prior to dispensing this medication? (3 marks)

b) How would you counsel this patient on the common adverse effects as well as the potential beneficial effects of tamoxifen? (6 marks)

c) You found out that the patient is also taking the following medications:

Pantoprazole 40 mg PO daily

Paroxetine 20 mg PO daily

Diltiazem ER 120 mg PO daily

Pravastatin 20 mg PO nocte

Please identify any possible drug interactions with tamoxifen and your recommendation for monitoring and/or optimize therapy (6 marks)